A 50-year-old man on ICU has cardiogenic shock following a large anterior STEMI. His cardiac index is 1.4 L/min/m2 on dobutamine 10 mcg/kg/min and nor...

Question

A 50-year-old man on ICU has cardiogenic shock following a large anterior STEMI. His cardiac index is 1.4 L/min/m2 on dobutamine 10 mcg/kg/min and noradrenaline 0.2 mcg/kg/min. Echocardiography shows EF 15% with a large LV thrombus. The team considers mechanical circulatory support. What is the key haemodynamic difference between VA-ECMO and Impella in LV support?

Accepted Answer

Impella directly unloads the LV (aspirating blood from the LV cavity and ejecting it into the aorta), reducing LV volume and wall stress; VA-ECMO provides oxygenation and circulatory support but increases LV afterload (retrograde aortic flow), potentially worsening LV distension if the failing ventricle cannot eject against the increased afterload

Answer

Both devices unload the left ventricle equally

Answer

VA-ECMO is always preferred over Impella

Answer

Impella provides oxygenation while VA-ECMO does not

Answer

Neither device affects LV afterload

uk-fficm MCQ (SBA): Mechanical Circulatory Support